Provider Demographics
NPI:1366471831
Name:STEWART, EDWIN T (CRNA)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:T
Last Name:STEWART
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:SABETHA
Mailing Address - State:KS
Mailing Address - Zip Code:66534-0229
Mailing Address - Country:US
Mailing Address - Phone:785-284-2121
Mailing Address - Fax:785-284-0550
Practice Address - Street 1:14TH & OREGON
Practice Address - Street 2:
Practice Address - City:SEBETHA
Practice Address - State:KS
Practice Address - Zip Code:66534
Practice Address - Country:US
Practice Address - Phone:785-284-2121
Practice Address - Fax:785-284-0550
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54131367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS144687OtherBCBS